Epidemiologic Considerations in Attention Deficit Hyperactivity Disorder: A Review and Update

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Epidemiologic data on attention deficit hyperactivity disorder (ADHD) are essential for planning health services and implementing strategies of detection and early intervention, with possible substantial benefits on public health. This article addresses methodological aspects of prevalence studies, recent findings on the prevalence of ADHD in childhood and adolescence based on a systematic review, current findings on the persistence of the disorder over time and prevalence in adulthood, and factors associated with ADHD. Evidence from the reviewed literature indicates the importance of methodological aspects in the understanding of epidemiologic findings and the necessity of large-scale cross-national studies. Moreover, governments clearly must direct attention to childhood mental disorders to guarantee a healthy future for their countries.

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Methodological aspects of surveys

To generate meaningful and valid prevalence estimates, epidemiologic surveys must address a host of methodological strategies. In addition, for ADHD studies, several specific methodological choices may result in different prevalence estimates [4]. Thus, different prevalence estimates are generated depending on the specific diagnostic criteria and system applied, informant source and strategies used to collect and combine diagnostic information, and whether and how the criterion of impairment is

Prevalence in childhood and adolescence

Given the growing interest and recognition of ADHD, its prevalence has been frequently studied in the past decade, with surveys conducted with different methodological approaches and in diverse cultures. Several reviews [11], [15], [16], [17], [18], [19], [20] have summarized this literature, including three systematic reviews that made rigorous efforts to ensure the unbiased selection of studies [4], [21], [22]. The most recent of these comprehensive systematic literature reviews [4] examined

Prevalence in adulthood

Longitudinal studies have consistently shown that ADHD symptoms tend to decline over time, but a considerable number of affected subjects remain symptomatic and impaired in adulthood, even if the full syndrome has remitted [90], [91]. Only recently has ADHD became a major focus of clinical attention [92] in studies of adults and among adult-oriented practitioners. Nevertheless, full agreement has not been reached on the phenomenology and diagnostic criteria of the disorder [93], [94], which

Demographic and psychosocial correlates

The most consistently reported demographic factor characterizing ADHD samples across epidemiologic studies is the higher rates of ADHD among men than among women. Table 2 shows the typical higher prevalence rates for men over women, averaging 11.3% and 5.4%, respectively (approximately a 2.4:1 ratio). Replicating the overall results from Table 2, an analysis of the 2003 National Survey of Children's Health (NSCH), which screened 102,353 children, showed that the diagnosis of ADHD was 2.5 times

Summary

This article reviews the major issues in the epidemiology of ADHD. ADHD surveys published in the past 10 years were selected based on a systematic search strategy. The review included 71 studies and the estimates reported showed an important variability. Findings are consistent with previous reports showing that the variability among prevalence estimates of childhood ADHD is related to methods used within specific surveys [4]. These findings indicate that the methodology of a given survey must

Acknowledgments

The authors thank Luis Augusto Rohde for his helpful suggestions on this article.

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    Funding sources: This work was supported by a research grant from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq, Brazil) (Grant MCT/CNPq 02/2006 - Universal). Dr. Polanczyk holds a doctoral fellowship, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Ministry of Education, Brazil.

    Conflict of interest: Dr. Jensen currently receives investigator-initiated grants from Ortho-McNeil Pharmaceutical, Inc. and unrestricted educational grants from Pfizer Inc., Eli Lilly and Company, and Ortho-McNeil Pharmaceutical, Inc.; participates in speakers' bureaus for UCB Pharma, psychCME, CME Outfitters, and the Neuroscience Education Institute; and consults with Best Practice, Inc., Janssen Pharmaceutica, Inc., Novartis, and UCB Pharma. Dr. Polanczyk has no conflict of interest to declare.

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